Lithotripsy and Dissolution Therapies

Oral agents used to dissolve gallstones and lithotripsy alone or in combination had gained some popularity in the 1990s, but have lost favor with the increase in laparoscopy. They still may have some value in specific circumstances.

Dissolution Therapies

Oral Dissolution Therapy. Oral dissolution therapy uses bile acids in pill form to dissolve gallstones and may be used in conjunction with lithotripsy, although both techniques are rarely used at present. Ursodiol (ursodeoxycholic acid, Actigall) and chenodiol (Chenix) are the standard oral bile acid drugs used for dissolution. Most doctors prefer ursodeoxycholic acid, which is considered to be among the safest of common drugs and does not seem to have significant side effects. Long-term treatment appears to notably reduce the risk of biliary pain and acute cholecystitis. The treatment is only moderately effective, however, since gallstones recur in the majority of patients.

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Patients most likely to benefit from oral dissolution therapy are patients with small stones (less than 1.5 cm in diameter) that have a high cholesterol content.

Patients that probably will not benefit from this treatment include obese patients and those that have gallstones that are calcified or composed of bile pigments

Only about 30% of patients, in fact, are candidates for oral dissolution therapy, and the number may be much lower, since compliance is often a problem. The treatment can take up to two years and can cost thousands of dollars per year.

Contact Dissolution Therapy. Contact dissolution therapy requires the injection of the organic solvent methyl tert-butyl ether (MTBE) into the gallbladder to dissolve gallstones. This is a somewhat technically difficult and hazardous procedure and should be performed only by experienced doctors in hospitals where research on this treatment is being done. Preliminary studies indicate that MTBE rapidly dissolves stones. The ether remains liquid at body temperature and dissolves gallstones within five to twelve hours. Serious side effects include severe burning pain.